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Direct evidence of endothelial injury during cardiopulmonary bypass by demonstration of circulating endothelial cells

Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Regensburg, Germany, fx.schmid{at}klinik.uni-regensburg.de

Bernhard Floerchinger

Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Regensburg, Germany

Nalini Kumar Vudattu

Department of Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany

Günther Eissner

Department of Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany

Marion Haubitz

Department of Nephrology, Hannover Medical School, Hannover, Germany

Ernst Holler

Department of Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany

Reinhard Andreesen

Department of Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany

Dietrich E Birnbaum

Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Regensburg, Germany

Endothelial activation is considered a key process in the development of a whole body inflammatory response secondary to cardiopulmonary bypass (CPB). Increased levels of a multitude of soluble mediators have been described as being released during and after cardiac surgery. Circulating endothelial cells have recently been established as a novel marker of endothelial damage in a variety of vascular disorders.

Blood samples from 20 patients undergoing elective coronary artery bypass surgery were obtained preoperatively and 1, 6, 12, 24, and 48 h after termination of CPB. Control samples were obtained from ten healthy volunteers. Circulating endothelial cells (CEC) were isolated with immunomagnetic anti-CD146-coated Dynabeads, and counted in a Nageotte chamber.

Low numbers of CEC were observed in healthy control volunteers (12±6 cells/mL; median: 9 cells/mL). CEC numbers were already significantly elevated in all patients before CPB, and there was a further significant increase after weaning from CPB (maximum increase at 6 h after CPB: 73±30 cells/mL; range: 30-153 cells/mL, p < 0.001).

The number of CEC provides further and direct evidence that CPB is associated with a pronounced endothelial injury and/or damage. CEC appear to be most useful markers for vascular endothelial activation because they are specific, stable, and circulating components of injured vessel wall.

Perfusion, Vol. 21, No. 3, 133-137 (2006)
DOI: 10.1191/0267659106pf860oa


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